Inspired Caring: A Culture of Innovating for Health and Value
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Transcript of Inspired Caring: A Culture of Innovating for Health and Value
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INSPIRED CARING: A Culture of Innovating For Health and
ValueA COMMUNITY HEALTH SYSTEM’S 10 YEAR
JOURNEYMark Herzog, FACHE
President & CEO
Laura Fielding,Administrative Director
Organizational Development
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HFM’s Silos…2001HFM…Today
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EVOLUTION OF OUR ORGANIZATION
• Strategy & Structure
• Business Plans & Facilities
2001
• Systems & Processes
• Quality/ Outcomes/ Safety
• Innovation Incubation
• Performance Improvement/VIP
2004
• Culture & Achievement
• Open Innovation, Flexibility
• Adaptation
2008
• Reform Readiness• Organizational
Repositioning• Proactive
Transformation
TODAY
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First-Curve to Second-Curve MarketsHOW WILL HOSPITALS SUCCESSFULLY NAVIGATE THE SHIFT FROM FIRST-CURVE TO SECOND-CURVE ECONOMICS?
4
• Fee-for-Service Reimbursement• High Quality Not Rewarded• No Shared Financial Risk• Acute Inpatient hospital focus• IT Investment Incentives Not
Seen by Hospital• Stand-Alone Care Systems Can
Thrive• Regulatory Actions Impede
Hospital-Physician Collaboration
VOLUME Based• Payment Rewards Population
Value: Quality & Efficiency• Quality Impacts Reimbursement• Partnerships with Shared Risk• Increased Patient Severity• IT Utilization Essential for
Population Health Management• Scale Increases in Importance• Realigned Incentives,
Encouraged Coordination
VALUE Based
THE GAP
AHA “Hospitals & Care Systems of the Future” Fall 2011
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Core Beliefs DRIVING HFM’S CARE SYSTEM DESIGN
RIGHT CARE - The most effective evidence based approach possible.
RIGHT SETTING - The most cost effective, safest, highest quality and greatest value.
RIGHT OUTCOME - Achieve the greatest long term benefit to the patient and society while minimizing physical and financial risk .
“Moving care to the right” is what makes HFM’s process, outcomes and value unique.
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THE PRICE IS RIGHT QUIZ!
An outpatient procedure?
6
How much might you pay, on average, for each of the following (match the service with the estimated price):
A doctors office visit?
A hospital stay?
$20,000
$2,000
$200
Which of these is a cornerstone of Population Health?
Doctor’s Office Visit
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5K
3K
4K
2011
2009
2007200520032001
INPATIENTVOLUME
OUTPATIENT VOLUME
Total Charges (less price increases)
18% Decrease Since 2001 8% Increase
Since 2001
43% Decrease Since 2001
$35M
$45M
$55M
$65M
HFM Inpatient & Outpatient Volume TrendsRELATED TO CHARGES
10/11/12
25% Reduction in Inpatient & Outpatient Market Volume
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0%
60%
20%
40%
201120092007200520032001
HFM
Aurora TR
Inpatient Market Share FOR THE TOTAL SERVICE AREA (HFM Transformation had minimal market impact)
2.9% Market Share Increase Since 2002
0.1% Market Share Decrease Since 2002
4.8% Market Share Decrease Since 2002
22% REDUCTION IN INPATIENT MARKET VOLUME SINCE 2002
Aurora BayCare
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Nationally recognized for Safety, Innovation & Thought Leadership
Focus on Wellness
& Prevention
90 Employed Providers
2001
90 bed hospital
35 Employed Physicians
Focus on the Sick
Population
HOSPITAL PHYSICIANS & NP/PA
MISSION FOCUS
RECOGNITION
10 Senior Leaders
SENIOR LEADERS
Locally Recognized
35 bed hospital
5 Senior Leaders
2012 HFM Care System Design
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2001 2006 2012
5749
44
106 5
Leadership Senior Leaders
Leading in new ways
▪ Conscious effort to flatten the organization
• Overall Reduced: -Network leadership by 27%-Senior leadership by 50%• Annual savings of $3.1 million from reduction• Role of outside eyes
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5K
3K
4K
201120092007200520032001
INPATIENTVOLUME
OUTPATIENT VOLUME
Gain From Operations (%)
8% Increase Since 2001
43% Decrease Since 2001
-2.0%
0.0%
2.0%
4.0%
HFM’s Margin While Transforming to a Second Curve Delivery Model
Source: WHA11
6.0%
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Days Cash on Hand
12
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
2011
2012
$60
$80
$100
$120
$140
$160
$180
$200
$220HFM
Aurora
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While Competitors Talk This Game, only HFM Walks the Talk Locally!
“Cost-Per-Episode vs. Unit PriceToo many health care purchasers focus on unit price, seeking to save money with the lowest cost provider for X-rays, office visits or surgical procedures. These initial “savings” are deceiving because they don’t take into account the most significant piece of the health care cost equation – how health care services are utilized. Low unit-price providers can actually increase employer costs if they order unnecessary tests or provide inefficient care that delays healing or causes a relapse.” 13
As stated on a competitor’s website.
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2K
5K
3K
4K
2011
2009
2007200520032001
INPATIENTVolume
OUTPATIENTVolume
Total Charges (less price increases)
70% Increase Since 2001
87% Increase Since 2001
1% Decrease Since 2001
Inpatient vs. Outpatient Volume Trends AURORA –TR & BAYCARE FOR TOTAL SERVICE AREA
14
6K
$30M
$40M
$50M
$60M
$70M
10/11/12
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201120092007200520032001
Local Service Area
Brown County
Regional Hospital Market Comparison HFM’s leadership has kept the lid on the cost of high utilization
30% Market Volume Increase Since 2001
39% Market Volume Increase Since 2001
8% Market Volume Increase Since 2001
Outagamie County
15
80K
60K
40K
20K
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2011
2009
2007200520032001
Outagamie
Total Service Area
110% Increase Since 2001
148% Increase Since 2001
$100M
$300M
$500M
$700M
Total Hospital Gross Charges 2001-2011For the Total Service Area, Brown, and Outagamie Counties
217% Increase Since 2001
12/19/12 Source - WHA
$900M
Brown
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2011
2009
2007200520032001
Holy Family Memorial
89% Increase Since 2001
Total Hospital Gross Charges 2001-2011For HFM and Aurora TR + BayCare in the Total Service Area
173% Increase Since 2001
12/19/12 Source - WHA
$30M
$50M
$70M
$90M
$110M
Aurora TR & BayCare
Excludes Open Heart
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If HFM Were the Only Choice UNCOVERING COST SAVINGS FOR MANITOWOC COMMUNITY
Amount our Community Spent
on Hospital CareIf Manitowoc
used HFM ONLY
$283 Million
- $255 Million
$28 MILLION!Reduced Cost for our Community
Assuming all hospital services were provided to Total Service Area residents by HFM from 2001 - 2011
That’s the power of “moving care to the right”!!
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50%
75%
100%
25%
0%
HFM’s CMS Value Based Purchasing
▪ Total Performance Score: 57
▪ Estimated Net Revenue Change: 0.1%
▪ Percentile Rank: 61
Source: The Advisory Board Company
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50%
75%
100%
25%
0%
HFM’s CMS Readmission Performance
▪ Estimated Penalty Percentage: 0%
▪ Estimated Net Revenue Change: $0
Source: The Advisory Board Company
Hospitals subject to 1% Penalty Cap
Hospitals subject to Penalty between 0% and 1%
Hospitals Not Subject to Any Penalty
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UW Population Health Model
21
Policies & Programs
Health Factors
Health Outcomes
Health Behaviors (30%)
Clinical Care (20%)
Social & Economic Factors
(40%)Physical
Environment (10%)
RANKINGS BASED ON THE FOLLOWING:
FOUR TYPES OF HEALTH FACTORS MEASURED:
1. Access to Care2. Quality of Care
Source: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute County Health Rankings model 2012
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Manitowoc County Clinical Care RankPOPULATION HEALTH
Manitowoc’s Clinical Care Rank out of 72 WI Counties:
▪ 2010: 31
▪ 2011: 23
▪ 2012: 18
22Source: Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute
Health Behaviors (30%)
Clinical Care (20%)
Social & Economic Factors (40%)
Physical Environment (10%)
42% Improveme
nt Since 2009!
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At 21st & Franklin Street, Sept. 2012
23
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Where bars trump grocery stores
24Source: flowingdata.com
More Bars
More Grocery Stores
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Measuring “Quality” in Healthcare
Key Thoughts:1. Purchasers, providers or patients who make a major
decision on solely one data source are not making a fully informed decision.
2. Two types of quality measurement firms:I. Independent & objective, or II. Aligned with purchasers as a negotiating tool
25
One thing is clear: Today there is no universal defining methodology or vendor
that purchasers, providers and patients agree on! Data quality & reporting vary greatly. Oversimplifying is risky.
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HIGH DEDUCTIBLE = CONSUMER DRIVEN
• Employers offer High Deductible Health Plans:
• Nationally 17% of employers offer HDHP; Deductibles range $3000 - $4000 (Futurescan 2012)
• Locally 60+% of large local employers & nearly all small employers offer HDHP, Deductibles range $5,000 - $10,000
• Insured population beset by the triple whammy of high deductibles, stagnant wages, and fear of job loss
• Result is, they prefer “not to know”
• How will insurance exchanges fill the role of care coach for policy-shopping consumers? Will they value provider continuity?
• Wellness/Prevention benefits dependent on employer HR leaders
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High Deductible= Consumer Driven
Employers offer High Deductible Health Plans: • Nationally 17% of employers offer HDHP; Deductible range
$3000 - $4000 (Futurescan 2012)
• Locally 60+% of large local employers & nearly all small employers offer HDHP; Many deductibles now range $5,000 - $10,000
Insured population beset by the triple whammy of high deductibles, stagnant wages and fear of job loss.
• Result; they prefer “not to know”.
How will insurance exchanges fill the role of care coach for policy-shopping consumers? Will they value provider continuity?
Wellness/Prevention benefits dependent on employer HR leaders.
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An HDHP Word of Caution
▪ HDHP are generally effective if properly designed and reflect an employee’s ability to fund the deductible, and they are educated about and compliant with wellness & preventive benefits.
▪ Considerable evidence exists that HDHP, combined with a soft economy, frequently mean important care & prevention forgone (mammo)
▪ Sign of the future: HFM’s Community Care program wrote off nearly $450,000 to insured patients, almost all with HDHP. (applied to bills to be written off because of economic hardship)
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HFM Employee Right Care Results
292008 2009 2010 2011 2012
72.273.6
74.5
72.6
74.6
Health Improvement - HRA Scores
Avg Age 46 85% Female
Avg Age 47 84% Female
Avg Age 47 84% Female
Avg Age 48 85% Female
Avg Age 48 85% Female
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HFM Employee Right Care Results
30
2008 2009 2010 2011 20120%
1%
2%
3%
4%
5%
6%
7%
% of Plan Population Requiring Hospitalization and Premium Im-
pact
No premiumincrease
No premiumincrease
No premiumincrease
No premiumincrease
Average of 1,500 participants
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HFM Employee Right Care Results
Inpatient stays in 2002Inpatients stays in 2012 33
- 91
$660k Saving
s
Average Hospital
Stay=$20k
124
Fewer Inpatient Stays
Inpatient stays by individuals covered under HFM’s health plan
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Recent Recognition
▪ REGIONAL RECOGNITION▪ 2010 New North Excellence in the Workplace▪ 2009 Manitowoc Chamber Business of the
Year
▪ TOP 2% NATIONALLY▪ Solucient 100 Top Performance Improvement
Leaders▪ Top 25 Most Wired – Small & Rural Hospitals▪ Healthcare Information & Management
Systems – Society Stage 6 ▪ 4x Recipient of HealthGrades Excellence in
Patient Safety
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THANK YOU!QUESTIONS